Establishment of an intermediate care ward for babies and mothers

Dear and McLain have shown clearly how the establishment of an intermediate care ward reduced the admission rate to their neonatal unit.' Although such a ward may be useful in some hospitals, a similar admission rate has been achieved at this hospital by different means. In 1979 the admission rate to the neonatal unit was 15-7%. Seven years later it had fallen to 5-2% of babies delivered at the hospital. This was achieved by nursing all babies who fulfilled the criteria described by Dear and McLain for admission to their transitional ward on the postnatal wards. Some babies weighing <1700 g were also nursed with their mothers on the postnatal wards, but all babies with respiratory distress or who required intravenous fluid replacement were admitted to the neonatal unit. The policy of nursing babies with special needs on the postnatal wards was effected by allowing all midwives of staff nurse grade and those newly appointed as sisters to spend six month periods on rotation to the neonatal unit. Thus expertise and familiarity with the problems of small babies were spread through the whole hospital. This policy of rotating midwifery staff had two additional advantages. Firstly, staff from the lying in wards were able to help out in the neonatal unit when required and, secondly, because all nursing staff had personal experience of the problems of the neonatal unit, this maternity hospital functioned as an integrated unit rather than the needs of special babies being separated from others.